Reversible Pancytopenia Due to Severe Iron Deficiency Anemia in a 12-Year-Old Girl

TL;DR

A 12-year-old girl with severe iron deficiency anemia showed reversible pancytopenia, which improved with iron supplementation and dietary changes.

Contribution

This case report demonstrates that severe iron deficiency can lead to pancytopenia in children, a rare but reversible condition.

Findings

The patient showed complete recovery after six months of iron supplementation and dietary changes.

Severe iron deficiency was confirmed by profoundly low ferritin levels and microcytic hypochromic red cells.

Abstract

Iron deficiency anemia remains a global health challenge among young children starting from birth. Pancytopenia is a rare presentation of iron deficiency in children, being highly reversible with a simple treatment strategy including diet modification and iron supplementation.

A 12-year-old Omani girl presented with a four-week history of fatigue, dizziness, and palpitations. Investigations revealed hemoglobin of 3.3 g/dL (11-14.5 g/dL), platelet of 47×109/L (150-450×109/L), white cell count of 3.9×109/L (2.4-9.5×109/L), and absolute neutrophil count of 0.5×109/L (1-4.8×109/L). Her red blood cell distribution width was high (34.1%; 11.5-16.5%), and her reticulocytes were normal (2.1%; 0.2-2%) with a mild elevation in the immature reticulocytes. Moreover, the ferritin level was profoundly low with a result of 1 ug/L only. Her peripheral blood smear showed pancytopenia in a background of microcytic and hypochromic red cells. After appropriate supplementation with oral ferrous sulfate in combination with an iron-rich diet, she showed complete recovery after six months from the initiation of management.

This case report highlights that iron deficiency can be a cause of severe pancytopenia in children.

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